Risk Factors For Cervical Dysplasia Research Articles

Socioclinical risk factors for cervical dysplasia and presence of human papillomavirus among women attending a tertiary care teaching hospital of Central Odisha

Abstract Introduction: Carcinoma cervix being the second-most common gynecological malignancy in India contributes nearly 14% of all cancers in females. Cervical dysplasia and presence of human papillomavirus (HPV) DNA are the two most important factors for developing cervical cancer. Hence, our study aims to be a flag bearer to raise the awareness for cervical screening with the main objective (i) to estimate the magnitude and distribution of cervical dysplasia among the women of 21–65 years and (ii) to find association between different socio-clinical risk factors and cervical dysplasia and HPV infection among the study subjects. Methods: It was a cross-sectional study carried out in a tertiary care hospital of Central Odisha, with a sample size of 176. Purposive sampling was done. Predesigned pretested questionnaire along with Pap smear and endocervical smear sample for HPV determination were used for data collection. Results: Nearly 62% of women suffered from cervical dysplasia. Women aged ≥35 years were found to have nearly thrice the risk of having cervical dysplasia. Nearly 20% of women tested positive for HPV DNA and these women were found to be 11 times more prone for developing cervical dysplasia compared to women tested negative for HPV DNA. Conclusion: Women with repeated genital infection with HPV and aged more than 35 years were more susceptible to cervical dysplasia. Those with early age at menarche, itching per vaginum, postcoital bleeding, and postmenopausal bleeding, etc., had a significant risk for developing cervical dysplasia. Hence, such symptomatic women should be made aware to undergo screening for cervical cancer at the earliest.

Role of Ureaplasma urealyticum and Ureaplasma parvum as Risk Factors for Cervical Dysplasia with Human Papillomavirus

Human papillomavirus (HPV) can be transmitted sexually and causes cervical malignancies in women. Among the risk factors, sexually transmitted infections (STIs) caused by bacteria have raised concerns because they are asymptomatic and persistent and can increase the risk of HPV infection. This study assessed the correlation among Ureaplasma urealyticum, Ureaplasma parvum, Chlamydia trachomatis, and Mycoplasma hominis infections towards abnormal cervical cells positive for HPV. Seventy outpatients at the Colposcopy Outpatient Clinic, Dr. Cipto Mangunkusumo Hospital in Jakarta, Indonesia, were enrolled in this cross-sectional study. Viruses and bacteria were detected using polymerase chain reaction and compared with liquid-based cytology results for cervical cytology. Of the 70 patients, 24 (34.28%) showed abnormal cervical cytology. Among those with abnormal cervical cytology, C.trachomatis was reported in 1 patient (4.2%), M.hominis in 6 patients (25%), U.urealyticum in 13 patients (54.2%), and U.parvum in 10 patients (41.7%). Statistical analysis demonstrated an association between U.urealyticum and U.parvum infections and HPV infection (U.urealyticum p = 0.012; U.parvum p = 0.022). U.urealyticum and U.parvum were more prevalent than C.trachomatis and M.hominis in HPV-positive women, suggesting their role in HPV infection.

Therapeutic human papilloma virus vaccination in patients at risk for cervical dysplasia.

Shared decision making between patients and their healthcare providers is recommended for use of the human papillomavirus (HPV) vaccine Gardasil 9 (9v-HPV) in women ages 27-45 years. We studied HPV vaccination as a treatment modality for patients undergoing colposcopy older than age 26 years who tested positive for high-risk subtypes of HPV (HR-HPV). A retrospective study (N.=155) was performed for patients that were evaluated for cervical dysplasia who tested positive for HR-HPV and received the 9v-HPV vaccine prior to repeat cervical cancer screening with co-testing. Demographic information, risk factors for cervical dysplasia, and treatment outcomes were assessed for response to vaccination as treatment. Repeat co-testing was negative for HR-HPV in 76 patients (49%) and was positive in 79 patients (51%). A greater percentage of Hispanic patients cleared the virus and Black patients had a greater percentage of persistent HR-HPV on repeat co-testing (P=0.047). When comparing those who cleared the virus and those who had persistent HR-HPV, there were no differences observed for associated risk factors for dysplasia, HPV subtype, cytology or colposcopy results, vaccine dosing interval, or total number of vaccine doses received. While the HPV vaccine is effective for prevention of infection by high-risk strains of HPV, it remains unclear whether 9v-HPV vaccine should be recommended as a treatment option in exposed patients beyond age 26. We recommend healthcare providers discuss usefulness of 9v-HPV vaccine with their unvaccinated patients 27 years and older at risk for cervical dysplasia.

Genotype-specific high-risk human papillomavirus infections and risk factors for cervical dysplasia in women with human immunodeficiency virus in Germany: results from a single-center cross-sectional study

ObjectiveWomen living with HIV have an increased risk of human papillomavirus (HPV) infection and cervical cancer. Little is known about genotype-specific HPV prevalence, the impact of antiretroviral therapy, immunological status,...

The relationship between hormonal contraception and cervical dysplasia/cancer controlling for human papillomavirus infection: A systematic review

ObjectiveStudies on the effect of long-term use of combined oral contraceptives (COCs) on cervical dysplasia and/or cancer risk have been inconsistent. Less is known about the effects of other forms of hormonal contraception (HC). We examine whether HC use increases the risk of incident cervical intraepithelial neoplasia (CIN) 2, 3 and/or cancer after accounting for preexisting human papillomavirus (HPV) infection. Study DesignSystematic review of prospective studies on HC use as risk factor for cervical dysplasia with HPV infection documented prior to outcome assessment including PubMed and EMBASE records between January 2000 and February 2020 (Prospero #CRD42019130725). ResultsAmong nine eligible studies, seven described recency and type of HC use and therefore comprise the primary analysis; two studies limit comparisons to ever versus never use and are summarized separately. All seven studies explored the relationship between oral contraceptive (OC) use and cervical dysplasia/cancer incidence: two found increased risk (adjusted odds ratio, aOR = 1.5–2.7), one found no association but decreased risk when restricted to women with persistent HPV (adjusted hazard ratio = 0.5), and four found no association. None of the seven studies differentiated between COC and progestin-only pills (POPs) by use recency or duration. The only study that included injectable progestin-only contraception (DMPA) found increased CIN3 incidence among current versus never users (aOR = 1.6). The one study that included Norplant found no association. Two studies included intrauterine device (IUD) use, but did not differentiate between hormonal and copper IUDs, and found no association. ConclusionWe found no consistent evidence that OC use is associated with increased risk for cervical dysplasia/cancer after controlling for HPV infection. There were too few studies of progestin-only injectables, implants or IUDs to assess their effect on cervical dysplasia/cancer risk. ImplicationsUse of single self-reported HC measures and insufficient distinction by hormonal constituent cloud our understanding of whether some HCs increase risk for cervical cancer. Methodologically rigorous studies with distinct HCs measured as time-varying exposures are needed to inform cervical cancer prevention efforts and improve our understanding of cervical cancer etiology.

RISK FACTORS OF PRE-CANCER CERVICAL DISEASES IN WOMEN OF REPRODUCTIVE AGE

Relevance. Today, the nature of the impact of the inflammatory process caused by Trichomonas infection on the persistence of HPV and immune response, as a consequence of the progression of intraepithelial lesions of the cervix, is not fully understood.
 Objectives: based on a retrospective clinical and statistical analysis to determine the risk factors for cervical dysplasia in women of reproductive age.
 Materials and methods. A clinical and statistical analysis for 392 medical records of patients of reproductive age with verified HPV and Trichomonas Vaginalis, who received pathogenetic therapy at the clinical bases of the Bogomolets National Medical University Obstetrics and Gynecology № 3 Department and LLC "Clinic Profimed" for 2015-2019. As a result of a retrospective study of patients systematized by age, complaints, the presence of genital and extragenital pathology, reproductive history and the state of reproductive function, social status.
 Results. According to the analysis of anamnesis indicators, the main risk factors for precancerous cervical conditions were: early onset of sexual life, menstrual disorders (29.1%), high incidence of childhood infectious diseases (63.5%), somatic pathology (71.2 %), irregular use of barrier contraception (19.9%), genital diseased caused by sexually transmitted infections (STD), including HPV and Trichomonas Vaginalis, frequent abortions (41.6%) and childbirth with cervical trauma, low level of medical and sexual cultures and smoking (65.3%). The systemic negative impact of numerous risk factors on the body contributed to cervical intraepithelial neoplasia (CIN) development in women of reproductive age.
 Conclusion. The retrospective study proves the need for stratification of patients with for CIN risk, requires management of cervical pathology in women with HPV and detected Trichomonas Vaginalis, which will increase the effectiveness of diagnosis, treatment and recurrence prevention.

Human Papillomavirus (HPV) Prevalence, Temporal Dynamics and Association with Abnormal Cervical Cytology Findings in Women from Croatia: Is there a Compounding Effect of Low-Risk/High-Risk HPV Co-Infection?

Human papillomavirus (HPV) is a major risk factor for cervical dysplasia and invasive cervical cancer; therefore, regular screening by cervical smear cytology or HPV testing is recommended. We aimed to determine the overall and risk group-specific HPV prevalence, age distribution, and temporal trends and to appraise the correlation of HPV positivity with abnormal cervical cytological findings. This retrospective, single-center study involved a total of 751 women (aged 18 - 67) concurrently subjected to HPV DNA testing and cervical cytology evaluation over a 10-year period in Zagreb, Croatia. Digene HC2 HPV DNA test (Qiagen Corporation, USA) was employed in screening specimens for both low-risk and high-risk HPV risk groups. The cytology was reported using the Bethesda system and in accordance with uniform classification of uterine cervix cytological findings in Croatia "Zagreb 2002". Statistical significance was set at p < 0.05. The overall HPV prevalence in our study population was 48.6%, and the 18 - 30 age group presented with the highest infection burden (p = 0.046). A decrease in low-risk and high-risk mono-positivity has been observed over the 10-year period; conversely, there was a significant increase in low-risk/high-risk co-positivity (p = 0.007). Low-risk/high-risk HPV co-infection resulted in a compounding effect which increased the occurrence of abnormal cells, HPV-associated changes and low grade squamous intraepithelial lesions (LSIL/cervical intraepithelial neoplasia grade I) in cervical cytology when compared to mono-infection with either low-risk or high-risk HPV. On the other hand, such effect has not been demonstrated for high grade squamous intraepithelial lesions (HSIL/ cervical intraepithelial neoplasia grades II and III). The overall HPV prevalence in female outpatients was high, underscored with rising co-positivity rates. Such co-infection with both low-risk and high-risk HPV (predominantly seen in women younger than 30) can exhibit a compounding effect in the occurrence of cytological abnormalities and low grade squamous intra-epithelial lesions (LSIL), which has to be considered in future diagnostic and screening algorithms.

Post-coital bleeding: What is the incidence of significant gynaecological pathology in women referred for colposcopy?

ObjectiveTo evaluate the incidence of underlying serious gynaecological pathology in women referred to colposcopy with post-coital bleeding. Main outcome measures.Incidence of precancer and cancer. MethodsA retrospective cohort study of women referred to colposcopy at a London hospital from January 2008-March 2015. Inclusion criteria are women with post-coital bleeding and the following cervical cytology history: negative; inadequate; never had. Multinomial logistic regression was used to assess for significant risk factors for cervical dysplasia and cancer. ResultsOverall, 635 women with either negative cytology (n = 436/68.7%), no previous cytology (n = 175/27.6%), or inadequate cytology (n = 24/3.8%) were referred to colposcopy for post-coital bleeding. The median age is 35 years (S.D. = 9.7 years). In 256 (40.3%) women, no cause was detected, and 322 (50.7%) women had a benign cause. Overall, 42 (6.6%) women had low-grade dysplasia, and eleven women had high-grade dysplasia (1.7%). Four women (0.6%) had cervical cancer; clinically evident cancer on speculum examination (n = 3); micro-invasive cancer (n = 1). Current smokers were significantly more likely to have HPV atypia (p = 0.015) or cervical intraepithelial neoplasm grade 1 (CIN1) p = 0.003. Advancing age was a significant risk factor for cervical cancer (p = 0.037). ConclusionAll women with post-coital bleeding need an urgent speculum examination to rule out frank cervical cancer. Although most women had a benign cause for post-coital bleeding, around 2% had a colposcopy-aided diagnosis of either cervical precancer or cancer; therefore, referral of symptomatic women deserves consideration. HPV testing may reduce referrals to colposcopy for post-coital bleeding due to non-significant pathology in the future.

English

AIMS: Prevalence of Sexually transmitted infections (STIs) tends to be high which constitutes an important public health problem at present worldwide and in India, being associated with Human Immunodeficiency virus and predisposing to cervical dysplasia and cancer. There is a need to overcome the STI infections throughout the nation by cytological and microbiological screening. SETTING AND DESIGN: The present study was undertaken to investigate the association of Chlamydia trachomatis (CT), Herpes simplex virus 2 (HSV 2), Cytomegalovirus (CMV), Hepatitis B (HBV), Hepatitis C virus (HCV), Trichomonas vaginalis (TV) and Candidiasis with cervical cytological changes in symptomatic female in West Bengal. METHODS: Sera and vaginal samples from 431 syndromic female patients with cervico-vaginal discharge were tested for detection of STIs. The study period extended over two years. Concomitantly, study of cervical cytology on Papanicolaou stained smears was performed in all cases. ELISA was performed for detection of CT IgM, HSV2 IgM, CMV IgM, HBsAg and HCV IgM in sera. Candida spp. and TV were identified by culture of vaginal samples. Cytological findings were interpreted according to Bethesda 2001 classification. Statistical analysis was performed using MedCalc for Windows, version 13.3.1.0 (MedCalc Software, Ostend, Belgium). RESULTS: Out of 431 samples, majority of the patients belonged to the age group of 29 to 42 years, however the mean age of patients presenting with HSIL on PAP was 45+ 7.93 years. CT, HSV2, TV and Candida spp. were associated with cervical cytological changes of ASCUS or worse. Age greater than 40 years and infection with CT emerged independent risk factors associated with cervical dysplasia on univariate and multivariate analysis with p <0.05 in both. CONCLUSION: C. trachomatis is a risk factor for cervical dysplasia. Early detection and treatment will prevent progression of STIs and development of cervical dysplasia and neoplasia.

Differences in risk factors for cervical dysplasia with the applied diagnostic method in Serbia.

In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences and sexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer. Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy. According to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were early beginning with sexual activities, presence of any STD in personal medical history and fear of the Pap test finding. The only risk factor found to be important for both methods was fear of the Pap testing finding.

Risk factors for cervical dysplasia in AMINU kano Teaching Hospital

Background: Cancer of the cervix remains the commonest cancer of the female genital tract in developing countries. Ironically, it is preventable by a well established screening program. A study of the risk factors will be needed in order to determine the group of women among whom cervical cancer screening should be further emphasized.Objective: To determine the risk factors of dysplasia among a cohort of women in Aminu Kano Teaching Hospital, Kano Nigeria. Method: A cohort study of 550 women, who attended the gynaecological clinic of Aminu Kano Teaching Hospital, between January 2008 and December, 2010.Results: The period incidence for abnormal pap smears in this study was 11.6%. Age ≥ 35years and parity ≥ 5, age at coitarche, first marriage and first childbirth ≤ 18 years, multiple marriages, divorcees, low educational and socioeconomic statuses, family history of cervical cancer, previous history of excessive vaginal discharge, and Human Immunodeficiency Virus infection (HIV) /Autoimmune Deficiency Syndrome (AIDS) did confer some risk of dysplasia, while women in first order marriage, single, widows, use of hormonal contraception, intermenstrual vaginal bleeding, cigarette smoking, history of genital warts did not.Conclusion: These groups of high risk women should be encouraged to have mandatory cervical cancer screening 3 years after coitarche.

A Clinical Study of Cervical Dysplasia in Long-Term Survivors of Allogeneic Stem Cell Transplantation

This retrospective study examined the prevalence of and risk factors for cervical dysplasia and genital human papillomavirus (HPV) infection in 89 female recipients of allogeneic stem cell transplantation (allo-SCT) between 1985 and 2005 who survived for more than 5 years after transplantation. All patients underwent regular gynecologic examination and cervical cytological testing. The incidence rates of cervical cytological abnormalities and HPV infection were calculated. Various clinical parameters were evaluated for association with cytological high-grade squamous intraepithelial lesion (HSIL) posttransplantation to identify risk factors for cervical dysplasia. Multivariate analysis with logistic regression was used to identify independent risk factors for cervical dysplasia after adjusting for confounding factors. Sixty-one of the 89 patients (68.5%) had cervical cytological abnormalities of varying grades, including atypical squamous cells of undetermined significance (ASC-US; 31.5%; 28 of 89), low-grade squamous intraepithelial lesion (LSIL; 10.1%; 9 of 89), and HSIL (27%; 24 of 89). HPV status was available for 43 patients, 12 of whom (27.9%) were HPV-positive. Among the 69 patients with normal cytological cervical smear findings pretransplantation, the incidence of cytological HSIL was 23.2% (16 of 69) posttransplantation. After adjusting for confounding factors, only unrelated HLA-matched donor and the presence of vulvovaginal chronic graft-versus-host disease (cGVHD) were independent risk factors for cervical cytology HSIL after transplantation, with the highest risk among patients with vulvovaginal cGVHD (adjusted odds ratio, 31.97). We conclude that long-term survivors of allogeneic stem cell transplantation are at high risk for cervical cytological abnormalities. Vulvovaginal cGVHD and unrelated HLA-matched donor were the only independent risk factors for cervical cytological HSIL in patients with normal cervical cytology before transplantation. Regular surveillance by gynecologic examination, including cervical cytological testing, in these patients allows for early diagnosis and effective management of cervical abnormality and decreases the burden of this potentially fatal, but treatable, condition.

Cervical dysplasia in Nigerian women infected with HIV

Objective To determine the prevalence of and risk factors for cervical dysplasia in HIV-positive women receiving care at the Jos University Teaching Hospital in Nigeria. Methods A total of 369 HIV-positive women had cervical cytology performed; HIV-1 RNA viral load and CD4 counts were measured. Results Of 369 participants, cervical dysplasia was present in 107 (29.0%) women. However, cervical cytology was abnormal in 252 (68.3%). Among those with abnormal cytology, 145 (57.5%) women had ASCUS, 56 (22.2%) had LSIL, and 51 (20.2%) had HSIL. Median CD4 lymphocyte count was lower in women with dysplasia compared with those without (142 vs 170 cells/mm 3; P = 0.04), while median HIV RNA viral load was higher in women with dysplasia (101 781 vs 77 479 copies/mL; P = 0.002). Low CD4 count (< 200 cells/mm 3) and evidence of HPV infection were significantly associated with cervical dysplasia. Conclusion A high prevalence of cervical dysplasia was found among HIV-positive Nigerian women, which was associated with increased immune suppression.

Low folate status as a risk factor for cervical dysplasia in Thai women

The relationship between folate status and the risk of cervical dysplasia was studied among Thai women. The subjects were composed of 44 women with low-grade cervical neoplasia (cervical intraepithelial neoplasm I), 70 women with high-grade cervical neoplasia (cervical intraepithelial neoplasm II, III, and carcinoma in situ), and 95 women who served as controls. The low folate status in these women showed a strong association with cervical dysplasia. Serum folate was markedly lower in both low-grade ( P < .01) and high-grade cervical neoplasia cases ( P < .01) compared with the control women. Using logistic regression, the odds ratio for low-grade cervical neoplasia with low serum folate level (<19.82 nmol/L) was 6.13, whereas that of the high-grade group with the same folate level was 5.57. The findings support the contention that folate deficiency of women in this study had an increased risk of cervical change.

Teaching residents humanistic skills in a colposcopy clinic.

The aim of this project is to add formal training and evaluation of humanistic skills for residents in a colposcopy clinic. Medical education of residents in office procedures has generally focused on proficiency in a particular technical skill and acquisition of clinical knowledge regarding management options. The literature supports assessing pattern recognition with visual images and observing a specific number of procedures to achieve proficiency. Little attention has been given to training residents to demonstrate sensitivity during procedures. However, we believe this is a key element, as the procedure involves anxious patients who are fearful of cancer and fearful of pain in their most private body parts. Further, women who have painful or unpleasant colposcopy procedures are less likely to follow up for further evaluation of treatment and may be at higher risk to develop cervical cancer. Colposcopy training for gynecology residents, family medicine residents, medical students, and emergency room sexual assault nurses is provided at a colposcopy clinic that performs more than 400 procedures per year. The majority of women are referred for colposcopy from outside clinics, and more than one third are non-English-speaking. We have added to our traditional didactics and case instruction curriculum a session dedicated to training residents in humanistic skills related to performing colposcopy. Topics of discussion include (1) how to ask sensitive questions regarding risk factors for cervical dysplasia, (2) how to explain the procedure and obtain consent, especially with non-English-speaking women, (3) how to educate patients about human papilloma virus (HPV) and prevention of cervical cancer, (4) how to speak to the patient and the attending physician during the procedure to reduce rather than increase anxiety, (5) how to provide comfort measures during colposcopy (e.g., using a warm speculum, using local anesthesia, hiding instruments from patient view), and (6) how to review findings during and after procedures. The discussion includes errors that previous residents have made and approaches that create effective, culturally sensitive role models. The training session participants are given feedback regarding statements or actions that may make patients anxious or less comfortable during and following clinical procedures. Residents are evaluated at the end of each rotation by faculty who rate their technical skills, visual pattern recognition, knowledge on the subject, and humanistic qualities. The training session participants have responded favorably to feedback about observed interactions with patients during procedures. Indications are that this training may improve the quality of care given by providers during colposcopy and other sensitive procedures. To document the curriculum's effect on patient satisfaction and care, we plan to pilot the use of a patient survey regarding physicians' humanistic qualities.

Cervical Dysplasia in Women Infected with the Human Immunodeficiency Virus (HIV): A Correlation with HIV Viral Load and CD4+ Count

Objectives. The incidence of cervical dysplasia and carcinoma is known to be increased in HIV-infected women. In addition, there is a positive correlation between HIV viral load (VL), CD4+ count, and opportunistic infections, as well as the incidence of various malignancies. This study compares HIV VL and CD4+ count with the presence of cervical dysplasia, as well as with the degree of severity of dysplasia.Methods. A retrospective chart review of 350 HIV-infected women with polymerase chain reaction (PCR) quantitation of viral load was performed to identify 82 women with biopsy-proven cervical dysplasia and 25 women without any significant cervical pathology. The highest plasma VL within a year of the patients' cervical pathology and corresponding CD4+ count was selected and compared with cervical pathology. Univariate and multivariate statistical analysis using Student's t test and logistic regression analysis was used to analyze the significance of other risk factors such as age, race, smoking history, history of illicit drug use, and prior sexually transmitted disease as well as of viral load and CD4+ count.Results. Of 82 cases of cervical dysplasia, 33 (40.24%) were mild (CIN I), 47 (57.32%) were either moderate or severe (CIN II–III) dysplasia, and 2 demonstrated invasive squamous cell carcinoma (2.44%). A significant statistical difference was found when comparing either HIV plasma VL or CD4+ T-cell counts with the presence of cervical dysplasia on biopsy (P < 0.005). However, only CD4+ count was identified as an independent risk factor for the presence of cervical dysplasia after multivariate analysis.Conclusion. In our population, there is a significant correlation between VL and CD4+ count and the presence of cervical dysplasia. However, VL does not appear to be an independent risk factor for cervical dysplasia in this population of HIV-infected women.

Serum Micronutrients and Cervical Dysplasia inSouthwestern American Indian Women

We carried out a clinic-based case-control study to assess serum micronutrients as risk factors for cervical dysplasia among Southwestern American Indian women, a group with high rates of cervical preinvasive lesions. Cases were American Indian women with biopsy-proven cervical intraepithelial neoplasia (CIN I or CIN II/III). Controls were from the same Indian Health Service clinics with normal cervical epithelium. We interviewed women about histories of sexually transmitted diseases, sexual behavior, diet, hygienic practices, cigarette smoking, and reproductive factors. Laboratory assays included serum for retinol (vitamin A), ascorbic acid (vitamin C), α-tocopherol (vitamin E), and red blood cell folate levels, DNA for human papillomavirus (HPV) typing, and tests for other sexually transmitted diseases. The strongest risks for cervical dysplasia were associated with cervical HPV infection [odds ratio (OR) = 3.2, 95% confidence interval (CI) = 2.2-4.6 and OR = 7.9, 95% CI = 4.8-13.1 for CIN I and CIN II/III, respectively]. With adjustments made for HPV infection and other relevant confounders, subjects in the lowest serum retinol quartile were at increased risk of CIN I compared with women in the highest quartile (OR = 2.3, 95% CI = 1.3-4.1). The data suggest that low serum α-tocopherol was associated with CIN II/III, although the adjusted OR was not statistically significant (OR = 2.0, 95% CI = 0.9-4.8). Low serum ascorbic acid and red blood cell folate were not associated with cervical dysplasia.

Effect of Total Plasma Homocysteine on Cervical Dysplasia Risk

We investigated whether total plasma homocysteine (tHcy) is associated with risk for cervical intraepithelial neoplasia (CIN). tHcy was evaluated, along with numerous risk factors for CIN and biochemical indexes of nutrients, in a previously reported study population of 294 subjects with CIN and 170 female controls without CIN. tHcy was significantly higher in cases than in controls (9.1 vs. 8.3 μmol/l, p = 0.002). Human papillomavirus type 16 infection [odds ratio (OR) = 6.7], oral contraceptive use (OR = 6.0), parity (OR = 2.2), and cigarette smoking (OR = 1.9) were significantly associated with CIN after adjustment for each other and for age, number of sexual partners, and plasma tHcy, folate, iron, and zinc. Human papillomavirus type 16 positivity increased risk for CIN more when tHcy was >9.12 μmol/l (OR = 4.7) than when it was ≤9.12 μmol/l (OR = 3.0). Cigarette use increased risk for CIN when tHcy was >9.12 μmol/l (OR = 3.9), but not when tHcy was ≤9.12 μmol/l (OR = 1.5). Parity increased risk for CIN more when tHcy was >9.12 μmol/l (OR = 4.0) than when tHcy was ≤9.12 μmol/l (OR = 2.0). These results suggest that elevated plasma tHcy is a risk factor for cervical dysplasia and that it enhances the effects of other risk factors. It is unknown whether tHcy is serving as a marker of folate deficiency or is acting through other mechanisms.

Viral characteristics of human papillomavirus infection and antioxidant levels as risk factors for cervical dysplasia

Genital human papillomavirus (HPV) infection is the major causal factor of cervical intraepithelial neoplasia (CIN). The potential role of nutrition as an additional, independent risk factor for CIN has not been appropriately addressed in the context of HPV. This case-control study evaluated the etiologic role of HPV in terms of viral type and load and examined the association between CIN and plasma levels of micronutrients adjusting for HPV. Cases (n = 378) with histo-pathologically confirmed CIN and controls (n = 366) with no history of abnormal Pap smears were recruited from colposcopy and gynecology clinics, respectively. Risk of CIN was significantly increased among women who were infected with multiple HPV types (odds ratio [OR] = 21.06), a high viral load (OR = 13.08) and HPV 16 (OR = 62.49). After adjusting for HPV positivity and demographic factors, there was an inverse correlation between plasma alpha-tocopherol and risk of CIN (OR = 0.15). Plasma ascorbic acid was protective at a high level of > or = 0.803 mg/dl (OR = 0.46). CIN was not associated with plasma retinol and beta-carotene levels. The effect of genital HPV infection on CIN development is highly influenced by oncogenic viral type and high viral load. Vitamins C and E may play an independent protective role in development of CIN that needs to be confirmed in prospective studies.

Risk factors for cervical dysplasia: Implications forprevention

This study assessed the aetiologic and public health importance of various risk factors for cervical dysplasia. A case-control design was used in which all cases had a histologically confirmed mild, moderate or severe cervical dysplasia. Controls were sampled from the general population. A total of 257 cases and 705 controls returned a postal questionnaire about marital status, sexual behaviour and contraceptive use, smoking behaviour and dietary intake of some nutrients. An increased risk was observed for women who were smokers and women whoreported more than one sexual partner. For women who reported more than six sexual partners, the adjusted odds ratio was 11.5 (95% CI: 6.6–20.2); for women who smoked more than 20 cigarettes per day, an adjusted odds ratio of 2.5 (95% CI: 1.6–3.9) was found. Use of oral contraceptives for more than 10 years increased the risk: the adjusted odds ratio was 2.3 (95% CI: 1.2–4.5). The population attributable risk percentage (PAR%) of these three risk factors together was 72%, while number of sexual partners, number of cigarettes smoked and oral contraceptive use alone amounted to a PAR% of 57%, 29% and 8% respectively. Considering the preventive potential against the background of causality of therelationships and the social acceptability of the proposed changes, it is concluded that cervical cancer and its precursors might for the greater part be prevented by behavioural changes, such as reducing smoking and using contraceptive barrier methods.